Flotation REST in Applied Psychophysiology

Thomas H.
Fine, M.A. and Roderick Borrie, Ph.D.

Thomas H. Fine is an Associate Professor in the
Department of Psychiatry of the MedicalCollege of Ohio. He began his research and clinical work with Biofeedback in 1975,
and, with John Turner, initiated the Restricted Environmental Stimulation
Therapy research program at MCO in 1978.

Roderick A Borrie, Ph.D. is a Clinical Psychologist at
South Oaks Hospital, Amityville, New York. He began his exploration of therapeutic uses of Restricted
Environmental Stimulation Therapy at the University of British Columbia with
Dr. Peter Suedfeld, and continues to use it in current work with patients
suffering chronic pain and illness.

Introduction

Restricted Environmental Stimulation Therapy (REST) has
fascinated many researchers, clinicians, and explorers of consciousness,
promising something special - a powerful transformation, a mystical peak
experience, an intense change in biochemicals, improved performance, or a
healing of our ills. Beyond the fascination, Flotation REST has established
itself as a unique method in the field of applied psychophysiology. Flotation
REST has proven to be a technique with predictable psychophysiological effects
and powerful clinical and performance applications. This article will provide
the reader with an introduction to the basic research into Flotation REST's
psychophysiological effects, and a brief overview of the clinical and
performance applications currently in use by REST clinicians and researchers.
The article will examine in greater detail the use of Flotation REST as an
intervention for chronic pain.

REST is an acronym for Restricted Environmental Stimulation
Technique, a name developed in the late 1970s by Peter Suedfeld and Roderick
Borrie for a technique that had previously been called Sensory Deprivation (SD)
or Sensory Isolation. Since much of the early SD research had been
misinterpreted, especially by writers of introductory psychology texts, a
widely accepted myth developed that SD environments were highly stressful, even
models for producing psychotic like experiences. This led to difficulties with
the Sensory Deprivation concept. Ultimately Suedfeld and Borrie proposed that,
since the process involves restricting the environmental stimulation that the
patient or subject experiences, REST would be a more accurate and less
provocative acronym.

Flotation REST is a special type of REST popularized by
John C. Lilly, M.D. Lilly developed an immersion system in the late 1950s at
that was used in early SD experiments. In the 1960s he developed a flotation
system in which a person floats in a light free, sound reduced chamber in a
highly concentrated solution of Epsom Salt and water maintained at a constant
temperature of 9,4.5 F (Lilly, 1977, p. 118).

Both Wet and Dry REST systems have been utilized in
research and practice. Wet-REST systems utilize flotation in salt water, and
Dry-REST systems utilize a modified REST environment in which a pliable 15 mm.
polymer membrane separated the floater from the fluid (Turner, Gerard, Hyland,
Neilands, & Fine, 1993).

At the Medical College of Ohio, John Turner and I conducted
a series of studies investigating the psychophysiological effects of brief
sessions of Flotation REST. The REST environment used in all of these studies
was a plastic or fiberglass chamber, approximately 1.1 m. x 1.3 m. x 2.5 m.
filled to a 25 cm. depth with saturated epsom salts (Mg SO) solution having a
specific gravity of 1.28 and temperature maintained at 34.5 C. The chamber was
light-free and the sound level was less than 10 decibels, with further
attenuation due to submersion of the ears in the solution. The general protocol
consisted of 30-40 minute sessions repeated approximately every third day with
a total number ranging from 4 to 20 sessions per study.

The first parameter we addressed was the subjective report
of the REST experience. We utilized several indices of subjective reports
including the Spielberger state anxiety scale, Zuckerman multiple affect
adjective checklist (Turner & Fine, 1990a), profile of mood states (POMS)
(Turner, Fine, Ewy, Sershon, & Frelich, 1989), and subjective rating scales
of emotion and relaxation. All of the initial studies found marked pre-post and
across-session changes indicating relaxation, an increase in positive emotion
and a decrease in negative emotions. In addition, an analysis of well over
1,000 descriptions of the REST experience indicated that more than 90% of
subjects found REST deeply relaxing.

Psychophysiological Effects of Flotation Rest

In choosing physiological parameters of the REST effect on
relaxation, we examined the basic physiological and biochemical hormonal
changes associated with stress responding. Physiological parameters measured
included blood pressure (BP), muscle tension (EMG), and heart rate (HR).
Hormonal parameters included both adrenal axis hormones such as ACTH,
epinephrine, norepinephrine, cortisol and aldosterone, and hormones not
mediating stress responding (luteinizing hormone and testosterone). Both within
and across-session decreases have been observed in various hormones. Hormones
directly associated with the stress response. Cortisol, ACTH and epinephrine
showed decreases during REST sessions, whereas luteinizing hormone, which is
not associated with the stress response, showed no change (Turner & Fine
1983). Likewise, across-session decreases were observed in adrenal-associated
hormones (cortisol, aldosterone, renin activity), while a hormone unrelated to
stress response (testosterone) did not shown across-session changes (Turner
& Fine, 1990a). In a separate study, we examined the across-session effect
on both mean cortisol values and their variability, observing a decrease in
both parameters (Turner and Fine, 1991). This suggests the possibility of a
resetting of the regulatory mechanism of cortisol across sessions. Furthermore,
cortisol, which has received more attention than the other hormones, and Blood
Pressure, have been shown to maintain the REST effect after cessation of
repeated REST sessions (Turner & Fine, 1983). This phenomenon suggests that
the REST effect may be more than a simple, immediately reversible response.

Interestingly, in comparing hormonal and BP changes in REST
with these changes in another relaxation condition (biofeedback), REST
consistently showed greater hormonal effects but similar BP effects to
biofeedback assisted relaxation (McGrady, Turner, Fine, & Higgins. 1987).
These results led us to consider that REST affects different mechanisms than
the biofeedback (since it affected cortisol levels when other methods did not)
or was simply more powerful (i.e. REST reached the threshold for cortisol
change but biofeedback did not).

Clinical Applications of Flotation REST

These results provide strong support for the hypothesis
that Flotation REST serves as a powerful relaxation inducer and has clinical
potential in working with patients who have stress-related disorders. There
have been several clinical studies that have employed REST as a treatment. The
disorders treated include essential hypertension, muscle tension headache,
anxiety disorders, chronic pain, psychophysiological insomnia, PMS, and
rheumatoid arthritis (Fine and Turner, 1985; Rzewnicki, Alistair, Wallbaum,
Steel, Suedfeld, 1990; Fine and Tumer, 1985; Goldstein and Jessen, 1990;
Turner, DeLeon, Gibson, & Fine, 1993). The treatment paradigms used in
these studies were similar, with REST serving as the primary method of
relaxation induction and training. All of these studies demonstrated positive
results from the use of REST. One of the unique effects of REST demonstrated in
these studies was that chronic pain patients frequently experienced an absence
of all pain during flotation, and that this spontaneous anesthesia could remain
for up to several hours after the session. Unfortunately, as with many
bio-behavioral treatment approaches, the large scale controlled trials have yet
to be undertaken.

Flotation REST and Performance Enhancement

A separate, exciting area is the use of Flotation REST in
the enhancement of human performance. Several studies, carried out primarily in
the research programs of Peter Suedfeld at the University of British Columbia
and Arreed Barabasz at WashingtonStateUniversity, have demonstrated enhancement
of scientific creativity, instrument flight performance, and piano performance.
Several studies of sports performance have had positive results including
studies of basketball, tennis, skiing, rifle marksmanship, and dart throwing.
In several of the studies the Flotation REST condition was varied with
relaxation, or imagery training and always had a more powerful effect. Often,
Flotation REST was used with imagery or without imagery, and no difference was,
found. Flotation REST, either wet or dry, was sufficiently powerful to affect a
change in performance. Barabasz suggests that because REST potentiates imagery
while disrupting over learned psychological processes, the technique is
especially suited not only for the acquisition of new im- proved skills but the
unlearning of less adaptive ones.

Flotation Rest and Pain Management

An in depth examination of the role of Flotation REST in
the management of pain can provide us with a clear picture of the
psychophysiological nature of the treatment. Pain programs are generally used
as a last referral resort for patients whose intractable pain has not responded
to the traditional medical treatments. Biobehaviorally based pain management
utilizes counseling and behavioral medicine techniques such as relaxation
training, meditation. biofeedback, guided imagery, and self-hypnosis. The goals
of such treatment are the development of pain avoidance skills, the
establishment of routines for optimal fitness within the limitations of a
disability, the reduction or elimination of pain, when possible, and/or the
patients acceptance of some level of pain.

Flotation REST can have an important role at several stages
of the pain management process. By reducing both muscle tension and pain in a
relatively short time and without effort on the part of the patient, flotation
provides a dramatic demonstration of the benefits of relaxation. Relief is
immediate and, although temporary, offers promise of further relief from REST
and other relaxation-based strategies. Symptom reduction gained from flotation
can increase a patient's motivation and interest in the remainder of the
therapy plan. Pain patients generally come into treatment feeling suspicious
and skeptical, requiring a clear demonstration that they can be helped.
Flotation can be the vehicle for that demonstration.

The relaxation following flotation can be used to
facilitate relaxation training. In the treatment reported here, training in
relaxation and other psychological pain control strategies occurred during the
flotation REST sessions as well as in counseling sessions. Specially prepared
audio programs introduced patients to breathing techniques, progressive muscle
relaxation, autogenic training, guided imagery and hypnotic suggestions for
pain reduction while they floated. Training and practice in those same
techniques followed in counseling sessions and at home.

The most common etiologies of pain in this group of
patients were from motor vehicle accidents, work accidents, or chronic illness.
Most had endured their pain for longer than six months and had also suffered
various levels of anxiety, anger, and depression. These emotional problems must
be considered in the treatment of chronic pain patients. The first data are
pre-post pain ratings from 16 patients who floated from one to 16 flotation
sessions. Each patient reported on up to four body areas, providing a total of
253 pre-post , measures. The average percentage of relief, as measured in
decrease from the pre-session value, was 31.3% for all sessions and all
measures. To determine whether flotation REST provides more pain relief to some
parts of the body as opposed to others, these measurements were examined by
body area. Pain reduction in most body areas was close to the overall mean of
31%, except the upper back, which showed a 63.6% pain reduction, the arms which
showed a 48.2% reduction, and the legs, which showed a 15.3% pain reduction.
The duration of relief varied from two hours to seven days.

A second set of data came from a survey mailed to patients
who had completed the program. The questionnaire asked patients to assess how
much pain relief they received from the various components of the pain program
(Flotation, relaxation training, and counseling) and from other treatments they
had received medication (pills and shots), physical therapy, chiropractic, and
surgery. Short-term pain relief, long-term pain relief, relief from anxiety or
stress, and relief from depression were indicated separately. Additionally,
they were asked whether each treatment improved their outlook and/or helped them
cope with their pain.

All 27 respondents had received treatments other than those
from this pain program: 81% had used pain medications; 56% had had some form of
pain injections; 70% had received physical therapy; 59% had received
chiropractic treatment; 22% had undergone surgery. These patients reported more
short-term and long-term pain relief from flotation than from the other
therapeutic modalities.

For non-pain symptoms, the comparisons were even more
striking. Patients reported far more relief from anxiety and stress from
flotation than any other modality. For depression, flotation was equal to
counseling at near 70%, with relaxation training at 53% and physical therapy
and medication at 20%. Patients also claimed to have reaped a variety of other benefits
from flotation, reporting improvements in sleep (65%), mental concentration
(77%), energy (46%), interpersonal relationships (54%), ability to work (35%),
ability to cope with pain (88%), ability to cope with stress (92%), and
feelings of well-being (65%) resulting from flotation REST.

In answering the question, "Did this treatment improve
your outlook toward your pain?" 96% responded positively for flotation,
100% for counseling, 100% for relaxation training, 50% for physical therapy,
24% for pain pills, 17% for pain shots, 15% for chiropractic. To the question,
"Did this treatment help you cope effectively with your pain?" 96%
responded positively for flotation, 92% for both relaxation training and
counseling, 50% for pain shots, 44% for pain injections, 38% for physical
therapy, and 17% for chiropractic. It is clear that flotation was rated on
average as more effective than other treatments with respect to pain, anxiety
and depression relief.

Flotation REST and Chronic Illness

Summing up thus far, the data are supportive of flotation
REST being useful in pain reduction, stress and tension abatement, and mood
enhancement. Besides chronic pain, other patients treated at our facility were
those with chronic physical illnesses, those with cancer, those with trauma to
the nervous system, those with depression or bipolar mood disorder. anxiety
disorders, and those suffering overwhelming stress.

Uniquely, Flotation REST provides an effortless
introduction to deep mental and physical relaxation. The majority of our
chronic illness patients suffered from autoimmune diseases, including
rheumatoid arthritis, lupus, scleroderma, and Reiters syndrome. For these
patients, discovering relaxation meant a dramatic reduction in symptoms, such
as joint pain, headache, fatigue and depression. Several patients with lupus
reported that regular flotation permitted them to reduce their dosage of
prednisone while experiencing less frequency and severity of symptoms. Two
patients with scleroderma reported relief from flotation. One reported relief
from pain and stiffness that lasted almost a week after her third flotation
session. As this patient continued she also experienced relief from her
depression about the illness, a dramatic reduction in her use of steroids and
other medications, a reduction in joint pain and swelling, and less frequent
heartburn and headaches. After a three month course of treatment with flotation
and counseling she was able to return to her job.

Flotation REST and Depression

When depression is in reaction to the circumstances of a
physical injury or illness, Flotation REST can produce an immediate elevation
in mood, probably due to the mood enhancing effects of deep relaxation as well
as the optimism that occurs with the experience of physical relief. When
depression is the primary diagnosis, flotation is best used as an adjunct to
counseling and then only after the patient has gained a modicum of feeling in
control. Caution is necessary in administering REST with depressed patients due
to the often obsessive nature of negative thinking that will continue during
the REST session. Once these patients have developed a better understanding of
their disorder, flotation REST can be a mood elevator that speeds the course of
therapy, especially when combined with positive guided imagery during the
sessions.

REST and Applied Psychophysiology

The REST environment can be viewed, from a biofeedback
perspective, as a system that enhances the connection between consciousness and
physiology by reducing external information rather than amplifying internal
information. We describe biofeedback as a process of amplifying and displaying
information about processes that we normally do not attend to or are unable to
discriminate from the wealth of informational noise always present. REST
reduces environmental noise, and in a flotation environment one is able to be
aware of all sorts of physiological information, (i.e. muscle tension, heart
rate, etc.) that we are often not aware of in normal quiet environments.

REST is an ideal environment for the acquisition of
biofeedback based learning. Many years ago Lloyd and Shurley published a paper
demonstrating its effect on the acquisition of single motor unit control.
Acquisition of single motor unit control was superior in the REST chamber
(Lloyd & Shurley, 1976). Our investigations found the same advantage with
heart rate control. Similarly Dry-REST environments might be exceptional
environments for neurofeedback training. While we have learned much about REST
in the last twenty years, its potential in applied psychophysiology has barely
been exploited. In this age of cyberspeak, we might begin to think of expanding
the clinical bandwidth of applied psychophysiology by taking another look at
REST.

Fine, T.H., & Turner, J.W., Jr. (1983). The Use of
Restricted Environmental Stimulation Therapy (REST) in the Treatment of
Essential Hypertension, First International Conference on REST and
Self-Regulation, 136-143.